World Neurosurg
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Case Reports
Moyamoya disease associated with tuberculum sellae meningioma and cavernous sinus hemangioma: case report.
Primary moyamoya disease associated with skull base tumors has been reported only rarely in the literature. Surgical treatment can be complicated due to the compensatory collateral circulation through meningeal and leptomeningeal anastomosis. A standard frontotemporal craniotomy may interrupt critical transdural anastomoses. ⋯ With careful bone flap design, moyamoya disease and skull base tumors can be treated simultaneously. Care should be taken to avoid interruption of critical dural-pial collaterals and injury to fragile moyamoya vessels.
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Case Reports
Safe burr hole surgery for chronic subdural hematoma using dabigatran with idarucizumab.
Chronic subdural hematoma (CSDH) is a common intracranial hematoma. The number of patients who undergo anticoagulant therapy including a direct oral anticoagulant (DOAC) is expected to increase. Recently, idarucizumab, the antidote for dabigatran, which is a DOAC, has been developed. We successfully treated CSDH with dabigatran using emergency burr hole surgery and idarucizumab. ⋯ Dabigatran should be used for atrial fibrillation detected after head trauma. Emergency surgery can be safely performed for CSDH with dabigatran using idarucizumab.
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To report a technique for endoscopic cystoventriculostomy guided by preoperative navigated transcranial magnetic stimulation (nTMS) and tractography in a patient with a large speech eloquent arachnoid cyst. ⋯ The combination of nTMS and tractography supports the identification of a safe trajectory for cystoventriculostomy in eloquent arachnoid cysts.
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Since the first resections of intradural extramedullary neoplasms, neurosurgeons have tended to preserve as much of the integrity of the spine as possible while ensuring a safe corridor to resect these lesions. A dimensional analysis of intradural lesions superimposed on a dimensional analysis of the thoracic canal would provide the anatomic basis for a minimal access approach. The authors report the results of such an analysis on a series of patients with intradural extramedullary lesions. ⋯ Thoracic intradural extramedullary lesions become symptomatic as they approach the limits of the thoracic canal, resulting in an inherent dimensional limitation in the rostrocaudal, lateral, and anteroposterior dimensions. Displacement of the spinal cord by the lesion to one side further favors a minimally invasive unilateral approach. A paraspinal unilateral hemilaminectomy approach with a 35 × 20 mm exposure centered over the lesion offers a safe surgical corridor for resection while preserving the posterior tension band, facet complexes, and paraspinal musculature.
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Posterior-anterior spondylodesis is often used to stabilize the spine in various pathologies. The anterior procedure is often performed via thoracoscopy. It is unclear whether the anterior procedure should be performed immediately after posterior instrumentation or after the patient has convalesced. This retrospective study compared perioperative safety and morbidity in 1-stage versus 2-stage posterior-anterior fusion surgery with a thoracoscopic anterior approach. ⋯ One-stage stabilization was as safe as 2-stage stabilization and associated with shorter hospitalization. Greater pain after the 1-stage procedure, which resolved 30 days after surgery, reflects the fact that 2-stage patients already had pain relief when they underwent thoracoscopy.